Antimicrobial Stewardship and Antibiotic Awareness Week at The Mater Hospital

Clinical Article

March 30, 2017

Antibiotic Awareness Week is a global health initiative held in the month of November (specifically during the week of 14-20 November in 2016). St Vincent’s Health Australia’s The Mater Hospital, in conjunction with HPS Pharmacies North Sydney, participated in this awareness week. This activity supports the ongoing Antimicrobial Stewardship (AMS) Program that operates within the hospital to continually optimise antimicrobial use. The AMS Program is made up of a multi-disciplinary team including Infectious Diseases Physician Dr Claudia Whyte, Infection Control Coordinator Julie McLaughlin, Director of Pharmacy Michael Soriano, nursing and hospital staff, along with HPS’ Clinical Pharmacists. HPS’ Clinical Pharmacists, together with Dr Claudia Whyte, were actively involved in conducting the National Antimicrobial Prescribing Survey (NAPS) Audit. During Antibiotic Awareness Week, Pharmacists provided education and inservices to hospital staff, as well as assessing nursing staff on their knowledge of antibiotics.

The NAPS Audit was conducted on 2nd November 2016 as a hospital-wide prevalence survey with any patient prescribed an antimicrobial included in the audit. Dr Claudia Whyte took the lead on the day and worked together with each Clinical Pharmacist on the wards to ensure consistency and transparency of data. This data has since been provided to the National Antimicrobial Utilisation Surveillance Program (NAUSP) for benchmarking and surveillance of overall usage. There was a total of 83 patients on antimicrobials on that particular day, equating to 35.9% of patients in the hospital. The most commonly prescribed antibiotic for surgical prophylaxis was cefazolin demonstrating a shift from cefalotin as shown in Table 1 below. All current guidelines recommend cefazolin be used as the first generation cephalosporin of choice demonstrating The Mater Hospital is in line with current guidelines.

Table 1. Antimicrobial Usage by Antimicrobial

Antimicrobial

Number

Percentage

Cefazolin

51

44.7%

Cephalexin

16

14.0%

Piperacillin-tazobactam

6

5.3%

Metronidazole

5

4.4%

Cefalotin

4

3.5%

Vancomycin

4

3.5%

Others

28

24.6%

The Mater Hospital – NAPS 2016 Audit data

In looking at The Mater Hospital’s appropriate use of antimicrobials, the AMS committee noted an improvement from previous NAPS audit surveys. The AMS committee, with the lead of Dr Claudia Whyte, will continue to focus on and work towards improving the appropriate use of antimicrobials and compliance with the Therapeutic Guidelines.

The focus of Antibiotic Awareness Week this year was to take the opportunity to bring to light once again the problem of antimicrobial resistance and to get everyone involved in being a part of the solution. Together with Julie McLaughlin, we were able to distribute the posters provided by the National Prescribing Service (NPS) around the hospital to create awareness amongst all hospital staff and patients alike. Using the above data, we were able to produce an inservice which focused heavily on the misuse and overuse of antibiotics across many industries including healthcare which increases the likelihood of resistance developing. The results of the NAPS audit were also presented and the processes of the AMS program highlighted with particular attention drawn to the elements that involve nursing staff. The following points were discussed with nursing staff.

Communicating and alerting the Clinical Pharmacists on the ward when a restricted “red” antimicrobial is prescribed and charted. This information is then gathered and reported to the AMS Pharmacist and subsequently to the Infectious Diseases Physician.

Checking pathology results when sensitivities are known and requesting a review of treatment (if required).

Informing the surgical team when a multi-resistant organism (MRO) has been identified during pre-admission screening.

Requesting a review of IV antibiotic treatment at 48 hours with a view to changing to oral medication at the earliest opportunity.

Including antibiotic review in all doctor’s rounds.

Ensuring the full course of any antibiotic treatment is completed both for patients and for people at home.

Being aware that there are infections that will not require antibiotics.

The nursing staff were given an opportunity to complete an assessment once they had participated in the inservice. There was a total of 57 attendees at the inservices and 23 of those completed the assessment. The median score for this assessment was 71%. The inservice and assessment were well received by nursing staff, who continue to follow up and ask questions to ward Pharmacists regarding the use of antimicrobials. The nursing staff were then reassessed in March 2017 to provide a comparison of the results. Overall, there were 34 nursing staff who completed the reassessment and the median score from the reassessment was 86%. This demonstrates the nursing staff have taken an active role in their learning, which contributes not only to their professional development, but also to their involvement in the AMS Program. A limitation of the reassessment includes not capturing the same staff in order to provide an accurate representation of the data collected. However, it did provide an opportunity to expose more staff including new nursing graduates to the AMS program and antimicrobial usage within the hospital.

Dr Claudia Whyte has since communicated the results of the NAPS audit to hospital administration and the VMOs, stating “It is important for us all to continue to work towards optimal prescribing of antimicrobials. The Mater Hospital is in a unique position of still having low rates of multi-resistant organisms, but this position is under threat with the increased rates in the community as a whole, and the burden of antibiotic usage.” HPS Pharmacies North Sydney continues to look forward to working together with The Mater Hospital and St Vincent’s Health Australia towards appropriate use of antibiotics and ultimately contributing to the reduced burden of antibiotic resistance.